8.18 Resource Person - Content

Demographics and administrative information about a person independent of a specific health-related context.

8.18.1 Scope and Usage

The Person resource serves as a linkage resource that may provide a reference set of common demographics
for an individual (human or animal) across multiple roles.
This linkage can be direct to role-specific FHIR resources (Patient, Practitioner and RelatedPerson)
residing on the same or possibly distinct FHIR systems/applications, or indirectly through the use of
business identifiers.

The Person resource may be used in many situations/contexts, including:

A set of demographics that can be used to co-ordinate the maintenance of this
de-normalized information across practitioners, patients and/or related personse.g. link known resources of the different types together within a system

A state/network based Master Person Indexe.g. A National Identifier Index or a Network membership/subscriber list

A central register that links patient resources from multiple servers, indicating they
all correspond to the same individuale.g. Within a large organization with many systems to be able to link the various records,
without having to modify the source information with external links

A support for access monitoring software that is able to assert what practitioner,
patient and related person records correspond to the same human being to assist in
detecting improper querying.e.g. asserting that a Patient A is the same individual as a RelatedPerson B who is
related to Patient C, who is also Practitioner D. As such, monitoring for Practitioner
D’s accesses to Patient A’s records should be carefully scrutinized.

Local record(s) on a mobile device listing links to remote server patient resourcese.g. A mobile phone application storing references to the hospitals they have access to

Note: The Person resource is an advanced feature. Many systems don’t have a way
to relate information across resource types, or systems, especially from Patient to
Practitioner, and therefore might not implement this functionality. Some do have ways
of relating the Patient and RelatedPerson resource types. FHIR is also able to do this
without the Person resource, utilizing the Patient.link property
(as shown in the Mother and newborn relationship example)

8.18.2 Boundaries and Relationships

Person resources may have references to Patient, RelatedPerson and/or Practitioner resources.
These linkages assert that all the records relate to the same individual.

Person instances are never directly referenced as actors (authors, subjects, performers, etc.)
Individual actors are always identified as either Patient, Practitioner or RelatedPerson, depending on the role
of the individual when undertaking the action. Therefore this resource SHALL NOT be referenced by any
other clinical or administrative resources.
E.g. it can be the focus of an operation or message or included in a Bundle,
but cannot be a member of a List or Group, the subject of an Observation, or other similar non-infrastructural usage.

In some use cases the linkages will be indirect, and through business Identifiers, such as in the case of
the various types of Master Person Indexes, where the records are not there for the purpose of healthcare,
but simply describing a population of people, and has other purposes and not just to represent a population patients.

8.18.5 De-normalized Data

Most of the properties of the Person resource are replicated within the other resources that they
are shared with. This is intentional and highlights the loose coupling of the resources.

Not many systems implement a shared Person record, and as such the values DO become out of
sync with each other. The inclusion of this resource does permit a capability for systems to identify
other instances of this actual person's data via a centralized registry that can assist in keeping things
up to date.

8.18.6
Person and Linking

The link element is used to relate resources under a common person record.
This element supports two primary scenarios where other resources refer to the same person resource.

The link element cannot be used to link to RelatedPerson entries, so we can use a Person
resource to relate these elements together identifying them as the same individual.

8.18.7
Cross-Domain Patient Directory

In a data sharing network, finding the location of patient records across different systems is a
necessary pre-requisite for accessing external patient data. Using the link element, systems associate
patient resources from different organizations. The assuranceLevel associated with the link provides
a way for a system to qualify its confidence in the asserted link. For example, a relationship from
the person to a patient using a probabilistic matching algorithm may be represented using a link with
an assurance level of level1, while a relationship established using a government-issued photo ID may
be created with an assurance level of level3.

8.18.8
Cross-Domain Provider Directory

Similarly, providers working in multiple healthcare service settings may be linked across different
organizations using the link element. The various practitioner resources can be related using a common
person resource with a link for each of the practitioner resources located in other organizations.

8.18.9
Person Master Index

Many national and state programs maintain a central register of people, and their key Identifiers.
These systems do not store any health related information, they are purely a validated set data, often
provided by government departments. These may contain identifiers for patients, practitioners from various
departments for various purposes. Access to these systems typically requires some form of professional
role or permission, such as those in healthcare, law enforcement, or other internal government uses.

These may also operate outside of government in the private sector, such as associations or networks
that a person may be involved with and may work in the same was as they do inside government.
The usage of the data into the healthcare environment is not the only use of the register.

Note: This style of system may use the Person resource without any FHIR references
to Patient or Practitioner resources. In these environments the Master Index is likely to
have a master identifier that performs this logical linking.
This style of usage has fewer security implications, as it doesn’t disclose where the
information is being used.

8.18.10
Client Portal

Client Portals provide consumer access to a window of their data locked up in healthcare systems.
In many cases these systems are externally integrated and do not have access to the legacy CIS/PAS systems.

In contrast to most systems where a user has access to multiple patients depending on their roles and permissions,
a client portal provides a consumer with direct access to their data (with permissions applied).
This can also include not just their data (via the Person.link Patient entries), but also to information that they
have entered, or were involved with (via the Person.link RelatedPerson entries), such as observations that they
entered.
With appropriate permissions/consent applied, the user could have access to other Patient records linked via
a RelatedPerson.

8.18.11
Security and Privacy Considerations

The Person resource may contain identifying and demographic information about an individual, therefore it must
be protected as Identifying Information.

The Person resource may contain references to the individual's other various Patient, Practitioner,
and RelatedPerson resources, where the referenced record might be to very sensitive information.
The access to the linked sensitive Resource may be protected, but the link itself may expose information.
For example where a Practitioner and Patient resource are linked through a Person resource, inspecting the
Patient URL could reveal that the Practitioner has a record at a sensitive medical health clinic (e.g. Drug Rehabilitation Clinic).

When implementing the Person resource consideration should be given to the security and privacy
of this information. Some mitigations to these risks include higher access control protections, filling
out the Person resource as sparsely as practical for the given use-cases, and masking some data elements for
certain users of the information. Additional security guidance can be found on the security page.

8.18.12 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.